EMA对说明书中辅料乳糖和环糊精安全性资料的最新要求

欧洲药品局（EMA）于2017年10月发布了"有关人用药品辅料环糊精的问答"文件，该文件回答了环糊精作为人用药品辅料使用中的安全性等问题。2018年11月EMA又发布了"人用药品辅料乳糖的包装说明书资料（草案）"文件，详细评价了乳糖的安全性。介绍上述2个文件中有关说明书中新的辅料乳糖和环糊精安全性资料撰写要求的内容，期望我国生产厂家借鉴欧盟的做法，在含有辅料乳糖和环糊精的说明书中提供乳糖和环糊精的安全性信息，确保用药者的安全。     

EMA对说明书中辅料聚山梨酯安全性资料的最新要求

欧洲药品局（EMA）于2018年11月发布了"人用药品辅料聚山梨酯的包装说明书资料（草案）"文件，详细评价了聚山梨酯的安全性。介绍该文件中有关药品说明书中辅料聚山梨酯安全性资料撰写的新要求，期望我国相关的药品生产厂家借鉴EMA的做法，在含有辅料聚山梨酯的药品说明书中提供聚山梨酯的安全性信息，确保用药者的安全。     

FDA对药品说明书和标签中有关谷蛋白声明的要求

美国食品药品监督管理局（FDA）的"供企业用对药品中的谷蛋白及其相关标示建议的指导原则（草案）"，详细分析了口服药品中谷蛋白的来源和含量并建议在有证据的情况下，在口服药品说明书和标签中列入"不含由含谷蛋白谷物（小麦、大麦或黑麦）制成的成分"的声明，以确保乳糜泻患者的用药安全。详细介绍该指导原则，期望引起我国药品上市许可持有人和药品监管部门对谷蛋白危害的重视。     

40份药品说明书中含醇辅料标注情况与安全性分析

目的：了解药品说明书中含醇辅料信息的标注情况,为合理使用药品提供参考。方法：根据《药品说明书和标签管理规定》和《化学药品和治疗用生物制品说明书规范细则》,对某院有使用记录的1 587份药品说明书"主要成分"、"辅料"及"注意事项"等项目中有关含醇辅料的标注信息进行统计,并分析筛选出药品说明书中各项下有关辅料含醇的安全性信息。结果：本次调查的1 587份药品说明书中明确标注了含醇辅料信息的药品说明书40份,占调查总数的2.52%。其中辅料含醇信息标注在"辅料"项下的药品说明书36份,标注在"主要成分"项下的药品说明书2份,标注在"包装"项下的1份以及1份药品未做标注,仅在"注意事项"中提及对酒精过敏者慎用。结论：药品说明书中关于含醇辅料信息及安全性信息的标注不规范,建议应对含醇辅料、含量标示及安全性信息等项目进行规范性标注。     

建立医院药品库房获得药品说明书的合法途径

目的：建立医院药品库房获得药品说明书的合法途径。方法依据《处方管理办法》对药品说明书在医院诊疗服务中的定位，建立以医院药品库房经药品供应商获得药品说明书的合法途径。结果药品说明书是医院安全合理用药具有法律意义的书面文件，由于医院从业的相关专业技术人员缺乏获得说明书的合法途径，可能制约了医院合理用药水平的提高，依据医院药品库房与药品供应商存在的直接联系，建立其经药品供应商获得生产厂家药品说明书的合法途径，意义重大。经尝试，结果显示，该渠道：简便、易获且快捷。结论药品库房经供应商获得药品说明书快捷有效。     

某院137个集采药品药品说明书中药用辅料标注情况分析

目的 为修订《药品说明书和标签管理规定》提供参考。方法 选取某院2021年12月使用的集中招标采购（简称集采）药品137个，包括国家集采品规126个和省集采品规11个，查找其药品说明书标注的药用辅料信息，并与3.4.3.0版美康合理用药系统收录的原研制剂电子版药品说明书相关信息（截至2022年3月）进行比较。结果 137个集采药品中，90个品规未标注药用辅料信息，包括82个口服制剂、7个注射剂和1个雾化吸入剂。与原研制剂剂型及规格相同的集采药品96个，其中集采药品与原研制剂均未标注药用辅料信息的55个（包括1个雾化吸入剂和54个口服制剂），标注一致的15个，标注不一致的26个。结论 药品说明书中辅料标注的相关法律法规及技术指南体系尚需进一步完善。建议我国相关法律法规强化药用辅料的标注，以确保用药安全。     

欧盟和美国对药品说明书【适应症】项目的撰写要求及启示

介绍欧盟和美国有关药品说明书[适应症]项目撰写的法规和指导原则，特别是最近欧洲药品管理局（EMA）发布的"治疗适应症的用语"。从这些管理文件得到的启示是相关法规规定不宜太粗糙，应具体、精准，应包括内容和格式的规定；而且要有指导原则伴随，以保证法规落到实处。熟悉掌握药品说明书[适应症]项目的撰写要求对规范撰写其他项目有普遍指导意义，对于药品说明书的监管也有裨益。     

美国食品药品管理局（FDA）对药品说明书中老年用药信息的要求及启示

美国食品药品管理局（FDA）于2020年9月发布了供企业用"处方药和生物制品说明书中的老年用药信息"指导原则。该指导原则主要介绍对说明书中老年用药信息位置和内容的要求并给出描述的示例。内容极其详细、具体，便于操作。而我国尚无类似指导原则，详细介绍该指导原则，期望对我国相关指导原则的起草及其上位法规的修订有帮助，对药品说明书老年用药信息的撰写也有益。     

基于药品说明书分析头孢菌素类皮肤过敏试验的医疗现状

目的：分析头孢菌素类皮肤过敏试验的医疗现状,为临床合理用药提供参考依据。方法收集和整理头孢菌素类注射剂药品说明书,应用对比法探讨不同品种药品说明书的皮肤过敏试验(以下简称皮试)表述、同品种不同厂家药品说明书的皮试警示、药品说明书与其他理论依据的皮试建议。结果不同品种药品说明书的皮试表述均存在完整性缺陷;同品种不同厂家药品说明书皮试警示存在差异;药品说明书与其他理论依据的皮试建议也有不同。这些差异及不同的存在,给皮试用药带来一定的医疗隐患。结论临床亟待法律性指导文件保障合理应用皮试药物,切实最小化药品风险。     

看似听似药品管理问题探讨和建议

目的：探讨看似听似（look-alike and sound-alike，LASA）药品管理中存在的问题，以期保证患者用药安全。方法：采用文献资料法，对LASA药品分类及产生原因进行比较分析。结果：LASA药品包括"看似"药品与"听似"药品两类。其中"看似"药品又包括名称与包装"看似"药品，"听似"药品又包括通用名"听似"、商品名"听似"的药品。"看似"药品的产生主要是由于语言体系内字符相似。此外，药厂为了固化品牌形象，有意按特定模式设计了不同产品的包装，导致大量外包装相似的药品的产生。住院及急诊工作人员人为将药品进行分装时，也会人为形成"看似"药品。不同药品通用名"听似"的主要原因是药品结构性之比较相似，药品商品名"听似"则多是药品公司出于商业考虑，进行品牌延伸所导致的。结论：建议通过管理审批中的药品名称及包装，补充LASA药品使用的管理规定；采用技术性方法区分、储存已上市的LASA药品；加强对LASA药品人工调配的规范化管理；推进分级诊疗，改善门诊用药环境及增强患者教育，构建用药安全文化来减少LASA药品导致的用药差错事件。     

益气活血通络方下调TGF-β/ERK信号通路对蛛网膜下腔出血大鼠的神经保护作用

目的探讨益气活血通络方对蛛网膜下腔出血大鼠TGF-β/ERK信号通路的影响及神经保护作用。方法 SD大鼠随机分为假手术组,模型组,益气活血通络方5、10、15 g/kg组和尼莫地平组,除假手术组外,其余各组建立蛛网膜下腔出血模型大鼠,分组处理后,各组大鼠进行神经功能缺损评分;以伊文思蓝染料外渗实验检测大鼠血脑屏障通透性;以TUNEL染色检测大鼠脑皮质神经细胞凋亡情况;以酶联免疫吸附法(ELISA)检测大鼠血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平;以蛋白免疫印迹法检测大鼠脑皮质组织TGF-β/ERK通路相关蛋白TGF-β1、p-ERK/ERK表达情况。结果与假手术组相比,模型组大鼠神经功能缺损评分、伊文思蓝渗出量、TUNEL阳性细胞比例、血清IL-6、TNF-α水平、TGF-β1表达、p-ERK/ERK明显升高(P0.05)。与模型组相比,益气活血通络方5、10、15 g/kg组和尼莫地平组大鼠神经功能缺损评分、伊文思蓝渗出量、TUNEL阳性细胞比例、血清IL-6、TNF-α水平、TGF-β1表达和p-ERK/ERK水平明显降低(P0.05),且益气活血通络方各组呈剂量相关性,益气活血通络方15 g/kg组与尼莫地平组相比,各指标比较差异无统计学意义。结论益气活血通络方可下调TGF-β/ERK信号,保护蛛网膜下腔出血大鼠神经功能。     

Prediction of Glass Transition Temperature of Freeze-Dried Formulations by Molecular Dynamics Simulation

Purpose. To examine whether the glass transition temperature (T_g) of freeze-dried formulations containing polymer excipients can be accurately predicted by molecular dynamics simulation using software currently available on the market. Molecular dynamics simulations were carried out for isomaltodecaose, a fragment of dextran, and -glucose, the repeated unit of dextran, in the presence or absence of water molecules. Estimated values of T_g were compared with experimental values obtained by differential scanning calorimetry (DSC). Methods. Isothermal-isobaric molecular dynamics simulations (NPTMD) and isothermal molecular dynamics simulations at a constant volume (NVTMD) were carried out using the software package DISCOVER (Material Studio) with the Polymer Consortium Force Field. Mean-squared displacement and radial distribution function were calculated. Results. NVTMD using the values of density obtained by NPTMD provided the diffusivity of glucose-ring oxygen and water oxygen in amorphous -glucose and isomaltodecaose, which exhibited a discontinuity in temperature dependence due to glass transition. T_g was estimated to be approximately 400K and 500K for pure amorphous -glucose and isomaltodecaose, respectively, and in the presence of one water molecule per glucose unit, T_g was 340K and 360K, respectively. Estimated T_g values were higher than experimentally determined values because of the very fast cooling rates in the simulations. However, decreases in T_g on hydration and increases in T_g associated with larger fragment size could be demonstrated. Conclusions. The results indicate that molecular dynamics simulation is a useful method for investigating the effects of hydration and molecular weight on the T_g of lyophilized formulations containing polymer excipients, although the relationship between cooling rates and T_g must first be elucidated to predict T_g vales observed by DSC measurement. January 16     

药品标签和说明书中药用辅料信息的规范标注

目的 进一步规范我国药用辅料在药品标签、说明书中的标注,保障公众用药安全、促进合理用药。方法 对比国内外相关法规规定,对我国药用辅料在药品标签及说明书中的标注问题提出完善的建议。结果 我国药用辅料在标签、说明书中标注的相关法律法规及技术指南体系尚需进一步完善。结论 建议我国相关法规规定做好顶层设计和统筹谋划,明确辅料定义和标注范围,制定相应的技术指南,使生产者易遵从、监管者可执行、使用者更安全。     

The Effect of Excipients on the Molecular Mobility of Lyophilized Formulations,as Measured by Glass Transition Temperature and NMR Relaxation-Based Critical Mobility Temperature

Purpose. The dependence of the molecular mobility of lyophilized formulations on pharmaceutical polymer excipients was studied. Molecular mobility as determined by NMR relaxation-based critical temperature of molecular mobility (T_mc) and glass transition temperature (T_g) is discussed in relation to the plasticizing effect of water in formulations. Methods. The T_mc and T_g of lyophilized -globulin formulations containing 6 different polymer excipients such as dextran, polyvinylpyrrolidone (PVP) and methylcellulose (MC) was determined by NMR and DSC. The molecular mobility of water in the formulations was determined by proton NMR and dielectric relaxation spectrometry (DRS). Results. T_mc varied with polymer excipients. T_mc increased as the ratio of bound water to mobile water increased and as the molecular mobility of mobile water decreased. The formulation containing MC exhibited a lower T_mc than the formulation containing dextran because of the smaller ratio of bound water and the higher molecular mobility of mobile water. The T_mc of the formulation containing PVP was higher than that expected from the higher T₂ values of water because of the lower molecular mobility of mobile water regardless of the higher ratio of mobile water. The T_mc of these lyophilized formulations was higher than their T_g by 23°C to 34°C, indicating that the formulations became a NMR-detected microscopically liquidized state below their T_g. Conclusions. The quantity and the molecular mobility of mobile water in lyophilized formulations can be considered to affect the T_mc of lyophilized formulations, which in turn governs their stability.     

Medicines containing pharmaceutical excipients with known effects: a French review

Objective: The 13/01/01 French decree published an official list of brands and their generic drugs and identified 38 groups of excipients with known effects which are responsible for side effects and contraindication respectively. Our objective was to review all medicines marketed in France containing these excipients and to disseminate this information to French health care practitioners.Method : The side effects and contraindications regarding these excipients have been documented in the French drug database Theriaque ( http://www.theriaque.org) . They were documented for each medicine containing these excipients in addition to the data mentioned in the Summary of Product Characteristics ( SPC) . Results were obtained on 1 June 2001 by using computerised queries from the database. Results: Within the 38 groups, 300 specific excipients and derivatives with known effects were identified. Among the 8900 medicines ( 100% ) , 5567 medicines ( 62.6% ) contained one or more of these excipients; 2483 contained 1 excipient, 1819 contained 2 excipients and 1265 contained 3 or more excipients; 410 side effects or contra indications – were described according to the route of administration and the threshold dose. They were linked to these 5567 medicines; 5818 excipients with a threshold dose were mentioned in the 'composition' sections of these 5567 medicines. Among these 5818 excipients, 3385 quantitative doses were documented in the SPCs or EPARs.Conclusion: This review shows the extent of most of the excipients contained in medicines marketed in France. The dissemination of these data offsets the lack of information in the SPCs.     

Protective Mechanism of Stabilizing Excipients Against Dehydration in the Freeze-Drying of Proteins

Purpose. To investigate the influence of type and amount of excipient on the preservation of the native structure and the biologic activity of freeze-dried lysozyme and catalase. Methods. The secondary structure of protein in the dried form and in aqueous solution was obtained using second derivative infrared spectroscopy and circular dichroism spectra respectively whilst the activity was determined using bioassay. Results. Small molecular excipients (glycerol, sorbitol, 1,6-anhydroglucose, sucrose, and trehalose) were found to stabilize the activity and/or the native structure of freeze-dried lysozyme and catalase, despite the processing temperatures being above Tg of excipient-protein mixtures. The preservation of catalase activity required excipient to be present at a lower excipient to enzyme mass ratio than that necessary to preserve native structure in the dried form. Combining dextran with sucrose synergistically protected the native structure of catalase but preserved the activity in an additive manner. Conclusion. The results indicate that the stabilization of catalase and lysozyme by excipients during dehydration was mainly due to water substitution rather than the formation of glass; the latter appearing not to be a prerequisite during freeze-drying.     

关联审评制度下药用辅料质量标准浅析

目的：研究关联审评制度下药用辅料质量标准现状，帮助理解关联审评制度下药用辅料质量标准内涵和各质量标准间存在的关系。方法：详细介绍关联审评制度下药用辅料质量标准的分类及特点，着重对现行药用辅料备案管理制度和药用辅料备案标准的制定要求、状态、变更、效力和现状等进行系统归纳、阐述，同时也对药用辅料备案标准和药典标准间的关系进行了分析、探讨。结果与结论：药品辅料的质量标准是药用辅料质量的重要衡量尺度，包括药典标准、注册标准、备案标准和内控标准等，其中药用辅料药典标准是对该辅料质量控制的基本标准和门槛；关联审评新制度下产生的药用辅料备案标准是监管机构确认辅料质量的重要文件。在关联审评制度的新时期，在进一步加深对药用辅料各质量标准的内涵和关系理解的同时，一方面需要企业对其备案的药用辅料进行更加广泛、深入的研究，以便给审评人员在关联审评时提供更多的参考依据；另一方面需要监管机构持续完善我国药用辅料药典标准体系，促进国内药用辅料质量标准整体提升，有助于提高我国制剂整体质量、推进制剂创新发展。     

Effects of Excipients on Protein Conformation in Lyophilized Solids by Hydrogen/Deuterium Exchange Mass Spectrometry

Purpose Excipients are added to lyophilized protein drug formulations to protect the protein during processing and storage, but the mechanisms are poorly understood. Here, hydrogen/deuterium (H/D) exchange with mass spectrometry was used to assess protein conformation and excipient interactions in lyophilized solids. Methods Calmodulin (CaM, 17 kD) was co-lyophilized with carbohydrate excipients (sucrose, mannitol, trehalose, raffinose, dextran 5,000, dextran 12,000) or guanidine hydrochloride (negative control) and exposed to D₂O vapor at 33% RH and RT. Samples were then dissolved and analyzed by mass spectrometry (+ESI/MS). Peptic digestion provided additional, site-specific information on H/D exchange. Solids were further characterized by powder x-ray diffraction (PXRD), differential scanning calorimetry (DSC), infrared spectroscopy (FTIR) and water vapor sorption. Results Excipients protected CaM from H/D exchange, increasing in the order guanidine hydrochloride < no excipient, mannitol < dextran 5,000, dextran 12,000 < sucrose < raffinose < trehalose. Effects were exerted primarily in the protein’s α-helical segments. Conclusions The effects of carbohydrate excipients on protein conformation in lyophilized solids are not exhibited uniformly along the protein sequence, but instead are exerted in a site-specific manner. The results also demonstrate the utility of H/D exchange with ESI/MS for protein structure characterization in lyophilized samples.